Contenu connexe Similaire à Chris Longhurst at BayCHI: Unintended Consequences of Healthcare IT Similaire à Chris Longhurst at BayCHI: Unintended Consequences of Healthcare IT (20) 1. +HDOWKFDUH ,QIRUPDWLRQ 7HFKQRORJ
$YRLGLQJ 8QLQWHQGHG &RQVHTXHQFHV
Tuesday, July 8, 2008
&KULV /RQJKXUVW 0' 06
$VVLVWDQW 3URIHVVRU RI 3HGLDWULFV 6WDQIRUG 6FKRRO RI 0HGLFLQH
0HGLFDO 'LUHFWRU RI &OLQLFDO ,QIRUPDWLFV /XFLOH 3DFNDUG &KLOGUHQ·V +RVSLWDO
2. :KDW LV PHGLFDO LQIRUPDWLFV"
ƒ ´7KH VFLHQWLILF ILHOG WKDW GHDOV ZLWK WKH VWRUDJH UHWULHYDO DQG
RSWLPDO XVH RI LQIRUPDWLRQ DQG GDWD LQ ELRPHGLFLQH µ
7HG 6KRUWOLIIH
ƒ ´+HDOWK LQIRUPDWLFV RU PHGLFDO LQIRUPDWLFV LV WKH LQWHUVHFWLRQ RI
LQIRUPDWLRQ VFLHQFH FRPSXWHU VFLHQFH DQG KHDOWK FDUH
+HDOWK LQIRUPDWLFV WRROV LQFOXGH QRW RQO FRPSXWHUV EXW DOVR
FOLQLFDO JXLGHOLQHV IRUPDO PHGLFDO WHUPLQRORJLHV DQG LQIRUPDWLRQ
DQG FRPPXQLFDWLRQ VVWHPV
:LNLSHGLD
6. 2YHUYLHZ *RDOV
ƒ 8QGHUVWDQG WKH FRQFHSW RI KLJK UHOLDELOLW LQ PHGLFLQH
ƒ 8QGHUVWDQG KRZ WKH (05 FDQ EH D WUDQVIRUPDWLRQDO WRRO LQ WKH
MRXUQH WRZDUG KLJK UHOLDELOLW
ƒ 5HYLHZ WKH VFLHQWLILF OLWHUDWXUH GHVFULELQJ XQLQWHQGHG
FRQVHTXHQFHV RI KHDOWK ,7 LPSOHPHQWDWLRQV
ƒ 3URJQRVWLFDWH DERXW QHDU WHUPKHDOWK ,7 LQQRYDWLRQV
7. 3HGLDWULFV -DQXDU
³7KHVH GDWD VXJJHVW WKDW
FKLOGUHQ KRVSLWDOL]HG LQ WKH 8QLWHG
6WDWHV H[SHULHQFH DQ DGYHUVH HYHQW
HDFK HDU RI WKHVH HYHQWV PD EH
SUHYHQWDEOH ´
9. 5HOLDELOLW RI ,QSDWLHQW 0HGLFDWLRQ 8VH
330 Difficulty with Referral
Mammography Screening
‡ • ‡ ‡‡ ‡ IRS - Tax Advice
(phone-in) (140,000 PPM)
Low
Back TX ‡ Airline Baggage Handling
U.S. ANESTHESIA
DEATHS
Inpatient
Post Heart Medication
Attack Safety Domestic Airline
‡
Flight Fatality
Medications Rate (0.43 PPM)
‡
'()(&76
6,*0$
6LJPD 6FDOH RI 0HDVXUH
10. ,QVWLWXWH IRU +HDOWKFDUH ,PSURYHPHQW ,+, GHILQHV +LJK
5HOLDELOLW
ƒ )DLOXUH IUHH RSHUDWLRQ RYHU WLPH IURPWKH SHUVSHFWLYH RI WKH SDWLHQW
ƒ 5HOLDELOLW ,QGH[
ƒ 8QVWDEOH SURFHVV )DLOXUH LQ JUHDWHU WKDQ RI RSSRUWXQLWLHV
ƒ RU IDLOXUHV RXW RI RSSRUWXQLWLHV
ƒ IDLOXUHV RU OHVV RXW RI RSSRUWXQLWLHV
ƒ IDLOXUHV RU OHVV RXW RI RSSRUWXQLWLHV
ƒ IDLOXUHV RU OHVV RXW RI RSSRUWXQLWLHV
ƒ IDLOXUHV RU OHVV RXW RI RSSRUWXQLWLHV
ƒ IDLOXUHV RU OHVV RXW RI RSSRUWXQLWLHV
11. /XFLOH 3DFNDUG &KLOGUHQ·V +RVSLWDO 2YHUYLHZ
ƒ 2SHQHG LQ
ƒ 0DMRU SHGLDWULF REVWHWULF KRVSLWDO
DVVRFLDWHG ZLWK 6WDQIRUG 8QLYHUVLW
ƒ 3DWLHQW VWDWV
ƒ N 'LVFKDUJHV
ƒ 'HOLYHULHV
ƒ N &OLQLF YLVLWV
ƒ $FWLYH %HGV
ƒ FULWLFDO FDUH SDWLHQWV
ƒ &HQWHUV RI ([FHOOHQFH
ƒ 7RS FKLOGUHQ·V KRVSLWDO E 86
1HZV :RUOG 5HSRUW LQ
FY 2004
12. ([DPSOH /3&+
&DWKHWHU $VVRFLDWHG %ORRG 6WUHDP,QIHFWLRQV
CVICU NNIS criteria
Central Line Associated Blood Stream Infections strictly applied
16
12
6.7 6.6
8
4 4.6
0
LPCH CDC Target LPCH Current 12 Mth Mean Goal Rate
13. ([DPSOH /3&+ 1,&8
Unique Adverse Events per Patient Adjusted by Birth Weight
1.6
1.4
LPCH
1.2
1
Rate
0.8
0.6
0.4
0.2
0
1 2 7 8 9 11 12 14 17 19 22 24 26 27 28
Hospital ID
Unique AE Rate Unique AE Adj Rate
14. ([DPSOH /3&+ :RUVH WKDQ FKDRV XQVWDEOH
Culture of Safety Survey 2002 vs 2004
(Weighted Scores)
30
P ercent P roblematic
24.7 24.26
25 23.1
18.2 16.95 19.1
20 17.3 17.68
15.5
13.7
15 12.1 11.07
10
5
0
Management/Organization Individual Shame/Blame Overall Average
Performance/Structure
PSC 2002 LPCH 2002 LPCH 2004
15. ,20 7R (UU LV +XPDQ
´'HVSLWH WKH FRVW SUHVVXUHV OLDELOLW FRQVWUDLQWV UHVLVWDQFH WR FKDQJH RWKHU
VHHPLQJO LQVXUPRXQWDEOH EDUULHUV LW LV VLPSO QRW DFFHSWDEOH IRU SDWLHQWV WR
EH KDUPHG E WKH VDPH KHDOWK FDUH VVWHPWKDW LV VXSSRVHG WR RIIHU KHDOLQJ
FRPIRUW
7R (UU ,V +XPDQ %XLOGLQJ D 6DIHU +HDOWK 6VWHP
/LQGD 7 .RKQ -DQHW 0 &RUULJDQ DQG 0ROOD 6 'RQDOGVRQ
(GLWRUV &RPPLWWHH RQ 4XDOLW RI +HDOWK &DUH LQ $PHULFD ,QVWLWXWH RI 0HGLFLQH
1DWLRQDO $FDGHP 3UHVV :DVKLQJWRQ ' &
16. 1(-0
“All practice errors can not be attributed to the human
causes of ignorance and avarice. Thus, I conclude that
though the individual physician is not perfectable, the
system of care is, and that the computer will play a
major part in the perfection of future care systems.”
17. (05 +LVWRU DW D *ODQFH
ƒ ·V ² UHVHDUFK
ƒ 3520,6 /DUU :HHG 8QLYHUVLW RI 9HUPRQW
ƒ 0<&,1 7HG 6KRUWOLIIH 6WDQIRUG
ƒ ·V ² KRPHJURZQ VVWHPV
ƒ +(/3 6VWHPDW /'6 +RVSLWDO 6DOW /DNH &LW 87
ƒ &267$5 DW +DUYDUG %RVWRQ 0$
ƒ 5HJHQVWULHI UHFRUG ,QGLDQRSROLV ,1
ƒ ·V ² FRPPHUFLDO VVWHPV LQWURGXFHG
ƒ ·V ² FRPPHUFLDO VVWHPV DUH ELJ EXVLQHVV
18. EMR Adoption Model (HIMSS 2007)
Stage Cumulative Capabilities % of US
hospitals
Stage 7 Medical record fully electronic; CDO able to contribute to EHR as byproduct of 0.0%
EMR
Stage 6 MD Documentation (structured templates), full CDSS (variance and 0.8%
compliance), full PACS
Stage 5 Closed loop medication administration 1.4%
Stage 4 CPOE, CDSS (clinical protocols) 2.2%
Stage 3 Clinical documentation (flow sheets), CDSS (error checking), PACS available 25.1%
outside of radiology
Stage 2 Clinical data repository, Controlled Medical Vocabulary, Clinical Decision 37.2%
Support System (CDSS) capability
Stage 1 Ancillaries – Lab, Rad, Pharmacy 20.5%
Stage 0 All three ancillaries NOT installed 19.3%
Source: HIMSS Analystics™ Database © 2007. N=5,073
19. /3&+ ,QIRUPDWLRQ .QRZOHGJH 6VWHP /,1.6
ƒ Cerner selected as LPCH partner
for IT applications in 2002
ƒ LINKS phase 1 went live in 2005 –
results review, unit clerk order
entry, pharmacy, radiology
systems, etc.
ƒ LINKS phase 2 went live in 2007 –
CPOE / Clinical Documentation
24. $UFKLYHV RI 0HGLFLQH 0D
³+LJK UDWHV RI $'(V PD FRQWLQXH WR
RFFXU DIWHU LPSOHPHQWDWLRQ RI &32(
VVWHPV WKDW ODFN GHFLVLRQ VXSSRUW ´
26. -RXUQDO RI 3HGLDWULF 6XUJHU
³2YHU WKH PRQWK VWXG SHULRG WKHUH ZHUH
LQ SDWLHQW GDV DQG GLVFKDUJHV 2XU
117 GDWD GHPRQVWUDWH WKDW &32( SUHYHQWHG
KDUPIXO $'( HYHU SDWLHQW GDV ´
27. &32( DQG 9HUEDO 2UGHU DW /3&+
For the time period 11/5 – 12/31 (excluding the perinatal service line*) LPCH is averaging a 93%
CPOE rate, and a 7% verbal order rate for the “live” areas.
100%
98%
97% 97% 96% 96% 96% 96% 97%
96% 96% 96% 96% 96%
95% 95%
94% 94% 94% 94% 94% 94% 94% 94% 94%
93% 93% 93% 93% 93% 93%
92% 92% 92% 92% 92% 92% 92%
91% 92% 92% 92% 92%
91% 91%
90% 90% 90% 90%
89%
90%
89% 89%
88% 88%
86%
85%
83%
81%
80%
% CPOE
70%
60%
50%
40%
30%
20% % Verbal 19%
17%
15%
14%
12% 12%
11% 11% 11%
10% 10% 10%
9% 8% 9%
10% 10%
9%
8%
7%
8% 8% 8% 8% 8% 8% 8% 8% 8%
6% 6% 7% 7% 7% 7% 7%
6% 6% 6% 6% 5% 6% 6% 6%
4% 4% 5% 4% 4%
4%
3% 3% 4% 4% 4% 4% 3%
2%
0%
* - obstetric areas allow the use of verbal orders per medical policy.
30. EMR Adoption Model
Stage Cumulative Capabilities % of US
hospitals
Stage 7 Medical record fully electronic; CDO able to contribute to EHR as byproduct of 0.0%
EMR
Stage 6 MD Documentation (structured templates), full CDSS (variance and 1.0%
compliance), full PACS
Stage 5 Closed loop medication administration 1.3%
Stage 4 CPOE, CDSS (clinical protocols) 2.1%
Stage 3 Clinical documentation (flow sheets), CDSS (error checking), PACS available 28.4%
outside of radiology
Stage 2 Clinical data repository, Controlled Medical Vocabulary, Clinical Decision 35.3%
Support System (CDSS) capability
Stage 1 Ancillaries – Lab, Rad, Pharmacy 13.1%
Stage 0 All three ancillaries NOT installed 18.9%
Source: HIMSS Analystics™ Database © Q1 2008. N=5,073
31. 7KH /DZ RI 8QLQWHQGHG &RQVHTXHQFHV
The “Law of Unintended
Consequences” encapsulates
the idea that almost all human
actions have at least one
unintended consequence,
where an action results in an
outcome that is not (or not
only) what is intended.
33. CPOE in a Children’s Hospital
8QH[SHFWHG
,QFUHDVHG 0RUWDOLW THE INFORMED PATIENT By
LAURA LANDRO
$IWHU Tech Glitches Can Slow Patient
,PSOHPHQWDWLRQ RI D Care
&RPPHUFLDOO 6ROG New Computers May Deliver
Turmoil When They Arrive;
&RPSXWHUL]HG One Study Cites Death Rates
3KVLFLDQ 2UGHU December 28, 2005; Page D6
(QWU 6VWHP A controversial study linking an
increased death rate to the
installation of a new computer
Yong Y. Han, et al. Pediatrics 2005;
116; 1506-1512 system at Children's Hospital of
Pittsburgh reinforces growing…
34. 3HGLDWULFV $SULO
³,Q VXPPDU ZH EHOLHYH WKDW LQDGHTXDWH
SUHSDUDWLRQ IRU &32( LPSOHPHQWDWLRQ KLJKOLJKWHG
³:H DSSODXG WKH DXWKRUV IRU KLJKOLJKWLQJ WKH
E LPSRUWDQFH RI FDUHIXOFKDQJHV LQVXIILFLHQW &32(
LQDSSURSULDWH SROLF ZRUNIORZ UHGHVLJQ LQ
LQIUDVWUXFWXUH DQG ODFN ZH FULWLFDO FDUH RUGHU VHWV QRW
LPSOHPHQWDWLRQ EXW RI FDXWLRQ RWKHU UHDGHUV
FRQWULEXWHG VXEVWDQWLDOO WR WKH &32( DV D WRRO WR
WR GLVPLVV WKH LPSRUWDQFH RI LQFUHDVHG
PRUWDOLW UDWH UHSRUWHG E +DQ DQG HQKDQFH SDWLHQW
KHOS SUHYHQW PHGLFDO HUURUV HW DO ´
VDIHW ´
35. &RQVHTXHQFHV RI +HDOWKFDUH ,7
Anticipated Unanticipated
Desirable Undesirable Desirable Undesirable
Goals Trade-offs Serendipity Today’s topic
Direct Indirect
Manage Acknowledge
36. -$0,$ 2FWREHU
³7KH SURMHFW WHDP OHDUQHG WKDW 8$&V RFFXU
GXULQJ DOO &32( LPSOHPHQWDWLRQV WKRXJK
QRW DOO LQVWLWXWLRQV H[SHULHQFH DOO RI WKH
WSHV RI 8$&V ´
37. 7SHV RI 8QLQWHQGHG $GYHUVH &RQVHTXHQFHV 8$&
0RUH QHZ ZRUN IRU FOLQLFLDQV
:RUNIORZ LVVXHV
1HYHU HQGLQJ VVWHPGHPDQGV
0LVJXLGHG DWWHPSWV WR HOLPLQDWH SDSHU
&KDQJHV LQ FRPPXQLFDWLRQ SDWWHUQV
1HJDWLYH HPRWLRQV
1HZ NLQGV RI HUURUV
&KDQJHV LQ WKH SRZHU VWUXFWXUH
2YHUGHSHQGHQFH RQ WHFKQRORJ
38. 8$& 0RUH 1HZ :RUN IRU &OLQLFLDQV
39. 8$& 0RUH 1HZ :RUN IRU &OLQLFLDQV
ƒ 3UREOHP
ƒ (05 VVWHPV FDQ VLJQLILFDQWO LQFUHDVH FOLQLFLDQ ZRUNORDG DQG LPSURYHG
VVWHPGHVLJQ PD QRW UHGXFH WKH DPRXQW RI QHZ ZRUN VXFK VVWHPV
UHTXLUH
ƒ 5HFRPPHQGDWLRQ
ƒ 0RUH ZRUN IRU WKH FOLQLFLDQ LV LQHYLWDEOH DQG PXVW EH DGGUHVVHG LQ WKH
SODQQLQJ SURFHVV
ƒ 6XFFHVVIXO LPSOHPHQWDWLRQV EDODQFH UHTXLUHG QHZ ZRUN ZLWK VVWHP EDVHG
UHGXFWLRQV LQ ROG ZRUN WR PDNH XVH RI WKH VVWHPV E FOLQLFLDQV WROHUDEOH
ƒ &RQVLGHU LQQRYDWLYH ZDV WR OHYHUDJH GDWD DOUHDG LQ WKH VVWHPWR
LPSURYH FOLQLFLDQ ZRUNIORZV
40. 3UHSRSXODWHG 3DSHU 3URJUHVV 1RWHV
ƒ(VWLPDWHG WR VDYH WR PLQXWHV
SHU KRXVH RIILFHUfacilitate document
Barcode to SHU PRUQLQJ
scanning
ƒ+HOSV WR RIIVHW LQFUHDVHG RUGHU HQWU
WLPH ZLWK &32(
ƒ$OVR KHOSV FRPSOLDQFH ZLWK $&*0(
Medication list, allergies, I/O
GXW KRXU JXLGHOLQHV ZKLFK OLPLW
summary, vital signs
UHVLGHQWV WR KRXU ZRUN ZHHNV
Some recent lab results (in
fishbone format) and all
microbiology results updated in
the last 3 days
43. 8$& 8QIDYRUDEOH :RUNIORZ ,VVXHV
ƒ Problem
ƒ Modeling clinical workflows is difficult because clinical practice is so
inherently complex, interruption-driven, and constantly changing.
ƒ 5HFRPPHQGDWLRQ
ƒ Recognize that no EMR system fits all workflows of a given hospital
perfectly. Even if a system initially did so, it would not eliminate the
need for constant system adaptation to changing workflows in the
future.
ƒ Realize that whenever there are adjustments, there will be
unintended consequences.
44. 8$& 1HYHU (QGLQJ 6VWHP'HPDQGV
45. 8$& 1HYHU (QGLQJ 6VWHP'HPDQGV
ƒ Problem
ƒ EMR systems evolve (i.e., are reconfigured, enhanced, or replaced)
over time, making hardware and software upgrades a necessity. As
changes occur, users must be retrained and quality assurance
measures must be reassessed.
ƒ 5HFRPPHQGDWLRQ
ƒ With each change, implementers should expect unintended
consequences. Although these consequences can be anticipated,
their extent is typically underestimated.
ƒ Adequate resources must be allocated for these ongoing
improvements!
46. 8$& 1HYHU (QGLQJ 6VWHP'HPDQGV
“EMR maintenance is like
repairing a jet engine in flight
because the consequences of
making mistakes are orders
of magnitude greater than for
less-integrated clinical
systems.”
47. 8$& 0LVJXLGHG $WWHPSWV WR (OLPLQDWH 3DSHU
ƒ 3UREOHP
ƒ :KLOH HOLPLQDWLQJ WKH SDSHU EDVHG PHGLFDO UHFRUG KDV FOHDU DGYDQWDJHV
RQH VKRXOG QRW FRQIXVH WKLV FRQFHSW ZLWK HOLPLQDWLQJ WKH XVH RI SDSHU E
FOLQLFLDQV LQ WKHLU HIIRUWV WR WDNH FDUH RI SDWLHQWV
ƒ 7KH UHDO JRDO LV WR GHFUHDVH RU HOLPLQDWH WKH GHSHQGHQF RQ LQHIIHFWLYH
SDSHU EDVHG SURFHVVHV WKDW IRUPEDUULHUV WR RSWLPDO KHDOWK FDUH GHOLYHU
ƒ 5HFRPPHQGDWLRQ
ƒ 3DSHU LV KHUH WR VWD IRU XWLOLWDULDQ DV RSSRVHG WR SHUPDQHQW UHFRUG
NHHSLQJ SXUSRVHV DQG DWWHPSWV WR OLPLW LWV SUDJPDWLF XVH LQ KHDOWK FDUH DUH
RIWHQ PLVJXLGHG
ƒ $FNQRZOHGJH WKDW SDSHU EDVHG FOLQLFDO UHFRUG VWRUDJH ZLOO EHFRPH
REVROHWH EXW XVH RI SDSHU LQ WKH FOLQLFDO VHWWLQJ ZLOO QRW
48. -+,0 )DOO
³7KH VLJQRXW UHSRUW JLYHV SKVLFLDQV QHHGHG
LQIRUPDWLRQ PRVW RI ZKLFK DOUHDG H[LVWV LQ WKH
KRVSLWDO¶V LQIRUPDWLRQ VVWHP 3KVLFLDQ
DFFHSWDQFH DQG HYHQ HQGRUVHPHQW RI &32(
VVWHPV PD EH DFKLHYHG E SURYLGLQJ WRROV DQG
UHSRUWV WKDW LPSURYH WKHLU HIILFLHQF DQG
ZRUNIORZ ´
49. /3&+ 6LJQRXW 5HSRUW ² 2YHUYLHZ
ƒ0XOWLSOH SDWLHQWV SDJH
ƒ$UHD IRU KDQGZULWWHQ QRWHV
ƒ'DWD DW RXU LQVWLWXWLRQ VXJJHVWV
UDSLG DGRSWLRQ
Usage of Signout Form
1600
1400
1200
Forms Completed
1000
800
600
400
200
0
1
on 2
3
M h4
M h5
6
M h7
8
on 9
M h 10
on 1
on 2
M h 13
on 4
M h 15
16
M h1
M h1
M h1
th
th
th
th
th
th
th
t
t
t
on
on
on
on
on
on
on
on
t
t
t
t
t
t
on
on
on
M
M
M
M
M
M
M
Month
50. 8$& 8QWRZDUG &KDQJHV LQ &RPPXQLFDWLRQ 3DWWHUQV
ƒ 3UREOHP
ƒ 6RPH GHVFULEH (05 DV SURYLGLQJ DQ ´LOOXVLRQ RI FRPPXQLFDWLRQµ EHFDXVH LW
SURPRWHV WKH EHOLHI WKDW HQWU RI DQ RUGHU LQWR WKH VVWHPHQVXUHV WKDW WKH
SURSHU SHRSOH ZLOO VHH LW DQG DFW XSRQ LW
ƒ 7KLV XQIRXQGHG EHOLHI LV HVSHFLDOO SUREOHPDWLF IRU ´VWDWµ HPHUJHQF
RUGHUV EHFDXVH WKHLU H[HFXWLRQ LQ D WLPHO IDVKLRQ VKRXOG GHSHQG RQ
LQWHUSHUVRQDO FRPPXQLFDWLRQ HYHQ SRVW (05 LPSOHPHQWDWLRQ
ƒ 5HFRPPHQGDWLRQ
ƒ $FNQRZOHGJH WKDW (05 LPSOHPHQWDWLRQ FDQ FKDQJH FOLQLFDO FRPPXQLFDWLRQ
SDWWHUQV
ƒ 7UDLQ XVHUV WKDW HOHFWURQLF RUGHUV GR QRW UHSODFH YHUEDO FRPPXQLFDWLRQ
51. 8$& 1HJDWLYH (PRWLRQV
ƒ 3UREOHP
ƒ 2UJDQL]DWLRQDO FKDQJH LV QHYHU HDV DQG VKLIWLQJ FOLQLFDO SUDFWLFHV DQG
ZRUNIORZV FDQ HQJHQGHU HQRUPRXV HPRWLRQDO UHVHQWPHQW LQ HQG XVHUV
ƒ 7KH DPRXQW RI WLPH D (05 VVWHPKDG EHHQ LQ XVH VWURQJO FRUUHODWHG
ZLWK WKH OHYHO RI SRVLWLYH HPRWLRQV WKH VVWHPHOLFLWHG
ƒ 5HFRPPHQGDWLRQ
ƒ 1HJDWLYH UHVSRQVHV FDQ SRLQW RXW VLJQLILFDQW SUREOHPV ZLWK WKH VVWHP
GHVLJQ DQG FDQ OHDG WR VROXWLRQV
ƒ 7UDLQLQJ DQG RSHQ FRPPXQLFDWLRQ FDQ KHOS WR SURPRWH EHWWHU
XQGHUVWDQGLQJ ZKLFK PD UHGXFH WKH QHJDWLYH HPRWLRQDO UHVSRQVHV WR
&32(
52. 8$& *HQHUDWLRQ RI 1HZ (UURUV
ƒ 3UREOHP² FOLQLFDO LQIRUPDWLRQ VVWHPV FDQ IRVWHU HUURUV
(UURUV LQ WKH SURFHVV RI HQWHULQJ DQG UHWULHYLQJ LQIRUPDWLRQ H J
MX[WSDSRVLWLRQ HUURUV IUDJPHQWDWLRQ RI IORZVKHHW GDWD
(UURUV LQ WKH FRPPXQLFDWLRQ DQG FRRUGLQDWLRQ SURFHVV H J ´WKH PLGQLJKW
SUREOHPµ DOHUW IDWLJXH ODFN RI FRQWH[WXDO UHOHYDQF
ƒ 5HFRPPHQGDWLRQV
ƒ (QG XVHUV PXVW EH PDGH DZDUH RI VVWHPOLPLWDWLRQV
ƒ 5HFRJQL]LQJ FXUUHQW XQLQWHQGHG FRQVHTXHQFHV VKRXOG HQFRXUDJH VVWHP
GHVLJQHUV WR RSWLPL]H IXWXUH KXPDQ FRPSXWHU LQWHUIDFH GHVLJQ
53. -$0$ 0DUFK
³7KDW &32( XVH PLJKW LQFUHDVH WKH OLNHOLKRRG RI
PHGLFDWLRQ HUURUV ZDV DQ XQDQWLFLSDWHG ILQGLQJ
ZKLFK ZRXOG QRW KDYH VXUIDFHG ZLWKRXW RSHQ
HQGHG TXDOLWDWLYH UHVHDUFK 7KLV UHVHDUFK
LGHQWLILHG SUHYLRXVO XQH[SORUHG PHGLFDWLRQ
HUURU VRXUFHV WKDW XVHUV UHSRUW WR EH IDFLOLWDWHG E
&32( ´
54. 3HGLDWULFV 1RYHPEHU
³,Q FRQWUDVW WR D UHFHQW TXDOLWDWLYH VWXG E
.RSSHO HW DO WKDW LGHQWLILHG WSHV RI HUURUV
UHODWHG WR &32( ZH IRXQG RQO WSHV RI &5(V
2XU VWXG KRVSLWDO XVHG D PRUH UHFHQW YHUVLRQ RI
WKH VDPH &32( VVWHP GHVFULEHG E .RSSHO HW DO
6RPH RI WKH SUREOHPV WKH GHVFULEHG PLJKW EH
LQIUHTXHQW RU VSHFLILF WR WKH ROGHU YHUVLRQ RI WKLV
VVWHP ´
55. 8$& 8QLQWHQGHG 3RZHU 6WUXFWXUH &KDQJHV
ƒ 3UREOHP
ƒ $V &32( VVWHPV HQIRUFH VSHFLILF FOLQLFDO SUDFWLFH SDWWHUQV ZKLOH DW WKH
VDPH WLPH PRQLWRULQJ FOLQLFLDQV· EHKDYLRUV WKH PD LQGXFH FKDQJHV LQ WKH
SRZHU VWUXFWXUH DQG FXOWXUH RI DQ RUJDQL]DWLRQ
ƒ 5HFRPPHQGDWLRQ
ƒ %HFDXVH &32( UHODWHG SRZHU FKDQJHV DIIHFW RUJDQL]DWLRQDO DQG SHUVRQDO
DXWRQRP WKH RIWHQ FDXVH VLJQLILFDQW 8$&V IRU HQG XVHUV 0RVW RIWHQ LW LV
WKH SKVLFLDQ ZKR ORVHV SRZHU WKLV PXVW EH UHFRJQL]HG DQG GHDOW ZLWK
H[SOLFLWO GXULQJ WKH &32( SODQQLQJ SURFHVV
56. 8$& 2YHUGHSHQGHQFH RQ 7HFKQRORJ
ƒ 3UREOHP
ƒ $V &32( WHFKQRORJ GLIIXVHV DQG EHFRPHV HQWUHQFKHG ZLWKLQ
RUJDQL]DWLRQV FOLQLFDO FDUH GHOLYHU EHFRPHV LQH[WULFDEO GHSHQGHQW XSRQ
LW 6VWHPIDLOXUHV LQFUHDVLQJO ZUHDN KDYRF ZKHQ SDSHU EDFNXS VVWHPV
DUH QRW LQ SODFH
ƒ 7KH PRUH ZLGHO DQG GHHSO GLIIXVHG WKH WHFKQRORJ WKH PRUH GLIILFXOW LW
EHFRPHV WR ZRUN ZLWKRXW LW
ƒ 5HFRPPHQGDWLRQ
ƒ 'HSHQGHQFH RQ WHFKQRORJ PXVW QHYHU EHFRPH VR JUHDW WKDW EDVLF PHGLFDO
FDUH FDQQRW EH SURYLGHG LQ LWV DEVHQFH
ƒ 3ODQQLQJ IRU PDQDJHPHQW RI XQH[SHFWHG GRZQWLPH LV FULWLFDO DQG RIWHQ
RYHUORRNHG
58. -$0,$ $SULO
³$OO RI XV LQYROYHG LQ KHDOWK FDUH ,7 QHHG WR
SUDFWLFH KHLJKWHQHG YLJLODQFH :H PXVW EH
FDXWLRXV ZKHQ PDNLQJEH RSWLPLVWLF LI ZH FDQ
³:H VKRXOG DOVR PDMRU FKDQJHV WKDW
PLJKWLGHQWLI WKH SUHVHQFH RI XQLQWHQGHG
KDYH XQLQWHQGHG FRQVHTXHQFHV DQG
EH SUHSDUHG WRFRQVHTXHQFHV LQHYLWDELOLW RI ZH
QHJDWLYH GHDO ZLWK WKH HDUO HQRXJK
FDQ GR VRPHWKLQJ DERXW WKHP ,I ZH FDQ
VXFK FRQVHTXHQFHV ´
UHDFK D KLJK HQRXJK OHYHO RI YLJLODQFH ZH
PLJKW EH DEOH WR FRPSOHWHO DYRLG PDQ RI
WKH VXEWOH VLOHQW HUURUV GHVFULEHG KHUH ´
60. $FNQRZOHGJHPHQWV
ƒ /3&+ $GPLQLVWUDWLYH OHDGHUVKLS
ƒ &KULV 'DZHV &(2
ƒ -LOO 6XOOLYDQ 93 RI 7UDQVIRUPDWLRQ
ƒ 3DP:HOOV 93 RI 1XUVLQJ
ƒ /3&+ 0HGLFDO OHDGHUVKLS
ƒ 3DXO 6KDUHN 0'
ƒ &KULVW 6DQGERUJ 0'
ƒ $XWKRUV RI WKH UHIHUHQFHG OLWHUDWXUH
ƒ FRSLHV RI DOO DUWLFOHV DUH DYDLODEOH RQ UHTXHVW
